Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, 243 Charles Street, Boston, MA 02114-4724, USA.
Am J Ophthalmol. 2010 Feb;149(2):221-228.e2. doi: 10.1016/j.ajo.2009.08.027. Epub 2009 Nov 24.
To conduct a cost-utility analysis and determine the cost-effectiveness of the Boston Keratoprosthesis (Boston Kpro).
Retrospective cohort study.
setting: The Massachusetts Eye and Ear Infirmary corneal service. patients: Inclusion required a minimum 2-year follow-up. Patients with autoimmune diseases and chemical burns were excluded. Eighty-two patients were included with various indications for surgery. intervention: The keratoprosthesis is a collar button-shaped polymethylmethacrylate (PMMA) device consisting of 2 curved plates sandwiched around a corneal donor (allo)graft. The device is assembled intraoperatively and sutured to a patient's eye after removing the diseased cornea.
Average cost-effectiveness of the keratoprosthesis was determined by cost-utility analysis, using expected-value calculations and time-tradeoff utilities. The comparative effectiveness, or gain in quality-adjusted life years (QALYs), was also sought. Cost-effectiveness was compared to recently published data on penetrating keratoplasty (PK).
A total discounted incremental QALY gain for the Boston Kpro of 0.763 correlated with a conferred QALY gain of 20.3% for the average patient. The average cost-effectiveness of the keratoprosthesis was $16 140 per QALY.
Comparable to corneal transplantation, with a cost-effectiveness between $12 000 and $16 000 per QALY, the keratoprosthesis can be considered highly cost-effective.
进行成本效用分析，确定波士顿角膜造孔术（Boston Kpro）的成本效益。
回顾性队列研究。
地点：马萨诸塞州眼耳医院角膜科。患者：纳入标准为至少 2 年的随访。排除自身免疫性疾病和化学灼伤患者。纳入 82 例具有不同手术适应证的患者。干预：角膜造孔术是一种纽扣状聚甲基丙烯酸甲酯（PMMA）装置，由 2 个弯曲的板夹在角膜供体（同种异体）移植物周围组成。该装置在手术中组装，在切除病变角膜后缝合到患者的眼睛上。
通过成本效用分析，采用预期值计算和时间权衡效用，确定角膜造孔术的平均成本效益。还寻求比较效益，即质量调整生命年（QALYs）的增益。将成本效益与最近发表的穿透性角膜移植术（PK）的数据进行比较。
Boston Kpro 的总折扣增量 QALY 增益为 0.763，与平均患者的 QALY 增益 20.3%相关。角膜造孔术的平均成本效益为每 QALY 16140 美元。
与角膜移植术相当，成本效益在每 QALY 12000 美元至 16000 美元之间，角膜造孔术可以被认为是非常有成本效益的。
